Half Of Adults In The U.S. Have Diabetes Or Pre-Diabetes, Study Finds

A national wake up call to intensify efforts to control the obesity crisis with added focus on diet, exercise and monitoring blood sugar

According to a study published online in JAMA today, nearly 50% of adults living in the U.S. have diabetes or pre-diabetes, a condition where a person already has elevated blood sugar and is at risk to develop diabetes.

Diabetes, a condition where blood sugar is elevated, may reflect lack of production of insulin to lower blood sugar (Type 1) or insulin resistance (Type 2), generally the result of obesity, poor diet or lack of exercise leading to the metabolic syndrome.

Diabetes is a costly disease in the U.S, racking up an estimated 245 billion in 2012, related to consumption and utilization of health care resources as well as lost productivity, according to the researchers in the study. Diabetes can damage blood vessels, the eyes and kidneys, also resulting in poor wound healing and devastating soft tissue infections. And nearly 71,000 persons die annually due to complications associated with diabetes, based on recent statistics from the American Diabetes Association.

Investigators in the study defined undiagnosed diabetes as those persons having a fasting blood sugar greater than 126 mg/dl or a hemoglobin A1C > 6.5 %, a measure of long term glucose control. Pre-diabetes was defined as having a fasting blood sugar 100-125 mg/dl, or a hemoglobin A1C of 5.7-6.4%.

Researchers evaluated 5,000 patients who were part of a national survey designed to assess the prevalence of diabetes and explore trends in different subgroups and ethnicities.

Results from the study indicated that in 2012, between 12% and 14% of adults had diabetes, the most recent data available. The majority of these diabetics are type 2, the result of poor diet, obesity and lack of exercise.

Researchers also uncovered that rates of diabetes among Asian Americans--who were previously an unstudied population--were as high as rates observed among other minorities. Up to 20% of Asian Americans had diabetes, with nearly 50% unaware of it.

Additional study data also revealed that up to 22% of African Americans had diabetes, compared to 11% among whites. Nearly 23% of Hispanics and 20% of Asians were noted to have diabetes.

Important to note, the proportion of undiagnosed diabetes was as high as 50% in Hispanics and Asian-Americans, while it was only about 33% in white and blacks.

The researchers also noted a sharp increase in diabetes from 1990 to 2008, with the incidence remaining steady thereafter.

According to the researchers, “Diabetes prevalence significantly increased over time in every age group, in both sexes, in every racial and ethnic group, by all education levels, and in all poverty income groups.”

The researchers also stratified the study participants by BMI, or body mass index, an indicator of obesity derived by dividing weight (in kg) by height in square meters. “When stratified by BMI, diabetes only increased among people with a BMI of 30 or greater,” the researchers wrote. A BMI > 30 indicates a person has obesity. The one exception noted was among Asian-Americans where an average BMI of 25 defined diabetes, classifying them as overweight but not obese.

A CDC study published in 2014 noted that 29 million persons in the U.S. had diabetes, with 86 million classified as having pre-diabetes--nearly a third of the U.S. adult population.

The natural question is how can we protect and monitor persons before they develop diabetes. While Hb A1C is certainly an accurate way to accomplish this, the use of sensors and novel technologies such as fluorescence utilized by researchers at University of Leeds in London via their Glucosense monitor to noninvasively track and monitor such parameters and Hb A1C and blood sugar may be the next frontier.

"The staggering numbers on metabolic disorders like diabetes and metabolic syndrome in our country and throughout the industrialized nations is a call to action," said Richard Able, Founder, X2 Biosystems and Partner, Stratos Group Seattle. "It's time for life science companies to deliver state of the art biometric monitoring platforms to the masses."

Able believes that early detection and monitoring is the key to help patients avoid slipping into the pre-diabetic state by keeping a close watch on their blood sugar, especially for high risk individuals.

"Clinicians and patients should be 'connected' by technologies adapted for self monitoring and data exchange," he explained.

I am an emergency physician on staff at Lenox Hill Hospital in New York City, where I have practiced for the past 15 years. I also serve as an adviser and editor to Medscape Emergency Medicine, an educational portal for physicians, and an affiliate of WebMD. My other time ...